Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 30025263 | OH |
Y | 1223P0221X | Pediatric Dentist | 1001353-15 | WI |
N | 1223P0221X | Pediatric Dentist | 30025263 | OH |
NPI | 1003262403 |
---|---|
Provider Name | Macaire Claire Hulderman |
First Address | Milwaukee, WI 53226-4874 |
Second Address | Milwaukee, WI 53226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2016 |
Last Update Date | 14/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0276108 | (05) | OH |
1003262403 | (05) | WI |